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A pharmacist-led structured group-based intervention (MEDIHEALTH) was formulated to improve medication adherence among Malay type 2 diabetes mellitus (T2DM) patients in the Malaysian state of Sarawak.The objective of this study was to examine the effectiveness of MEDIHEALTH and its mechanism of impact for improving medication adherence and the glycated haemoglobin (HbA1c) level.A two group and parallel randomised controlled trial with a twelve months follow-up period was conducted at two primary health clinics in Malaysia that were surrounded by Malay communities. Malay T2DM patients whose HbA1c was7% and total score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was26 were recruited and parallelly randomised to the MEDIHEALTH or usual care (control) groups. The extended theory of planned behaviour was employed to test the mechanism of impact. Repeated measure analysis of variance was used to assess the difference in the estimated marginal mean of the SEAMS scores and HbA1c level between the intervention and control groups at different times.A total of 142 participants were recruited and randomised; three from the intervention group and eight from the control group withdrew before receiving any treatment. Hence, 68 participants in the intervention group and 63 in the control group were included for analyses. The MEDIHEALTH group had a significantly greater increase in the SEAMS score compared to the control group (p 0.001) at one, three, six and twelve months post-intervention. There was also a significantly greater reduction in HbA1c in the MEDIHEALTH compared to the control group at one, three, six and twelve months post-intervention (p 0.001). These improvements were mediated by enhancements in perceived behavioural control and knowledge about medications.The MEDIHEALTH may improve medication adherence and glycaemic control among Malay T2DM patients.

Introduction: Past studies pay little attention to the intention to donate hematopoietic stem cells (HSC) among blood donors. This study investigated the level of and the influence of socio-demographic characteristics, knowledge, attitude, subjective norm and self-efficacy on the intention to donate HSC among blood donors. Methods: This cross-sectional study recruited blood donors at selected public hospitals in the Malaysian State of Sarawak in 2019. A structured questionnaire was developed based on the review of relevant literature. It gathered information on socio-demographic characteristics, knowledge, attitude, subjective norm and self-efficacy on the intention to donate HSC. Variables with a p value Results: A total of 569 blood donors participated (94.5% response rate). Overall, 87.1% reported a positive intention to donate HSC. In the regression model, the factor with the greatest association with intention to donate HSC was subjective norms about HSC donation (β = 0.35, 95% CI 0.27–0.42), followed by attitude about regulations of HSC donation (β= 0.21, 95% CI 0.13–0.35), self-efficacy on HSC donation (β = 0.15, 95% CI 0.09–0.32), attitude about the potential side effects of HSC donation (β = 0.14, 95% CI 0.02–0.10) and highest education level (β = 0.10, 95% CI 0.03–0.44). Conclusions: The findings can be used to formulate a better strategy in promoting HSC donation among blood donors in the region.

Introduction: We examined the association between admission body mass index (BMI) and discharge rehabilitation functional outcome using the Functional Independence Measure (FIM) in an East-Asian cohort of stroke patients during inpatient rehabilitation. Methods: A prospective observational cohort study of stroke patients admitted to a single inpatient rehabilitation unit was conducted. Using the World Health Organisation Asian standards, BMI was classified as underweight (< 18.5 kg/m2), normal (18.5–22.9 kg/m2) and overweight (≥ 23 kg/m2). The primary outcome measure was discharge FIM, and secondary outcomes included FIM gain, FIM efficiency and FIM effectiveness. Results: 247 stroke subjects were enrolled (mean age 59.48 [SD 12.35] years, 64.4% [159] male, 52.6% [130] ischaemic stroke). The distributions of underweight, normal and overweight BMI were 10.9% (27), 33.2% (82), and 55.9% (138) respectively on admission and 11.7% (29), 38.1% (94), and 50.2% (124) respectively on discharge. Significant small decreases in BMI from admission (median [IQR]: 23.58 [23.40, 24.70]) to discharge (median [IQR]: 23.12 [22.99, 24.21]) (p < 0.001) were found. Similarly, clinically significant FIM gains (mean FIM 26.71 [95% CI: 24.73, 28.69], p < 0.001) were noted after 36 days of median length of stay. No significant relationships were found between BMI and discharge FIM (p = 0.600), FIM gain (p = 0.254), FIM efficiency (p = 0.412) nor FIM effectiveness (p = 0.796). Conclusion: Findings from this study unequivocally support the benefits of acute inpatient stroke rehabilitation. Patients in the obese BMI range tended to normalise during rehabilitation. BMI, whether underweight, normal, or overweight was not correlated with discharge FIM.

We aimed to determine the prevalence, risk factors, and outcomes of acute kidney injury (AKI) within an ERAS program for colorectal surgery (CRS). This is a retrospective case–control study conducted from March 2016 to September 2018 at a single tertiary hospital in Singapore. All adult patients requiring CRS within our ERAS program were considered eligible. Exclusions were stage 5 chronic kidney disease or patients requiring a synchronous liver resection. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. Secondary outcomes included mortality, major complications, and hospital length of stay. Patient, surgical, and anaesthesia-related data were analysed to determine factors associated with AKI. A total of 575 patients were eligible for the study. Twenty patients were excluded from the study leaving 555 patients for analysis. Mean age was 67.8 (SD 11.4) years. Seventy-four patients met the criteria for AKI (13.4%: stage 1—11.2%, stage 2—2.0%, stage 3—0.2%). One patient required renal replacement therapy (RRT). Patients with AKI had a longer length of stay (median [IQR], 11.0 [5.0–17.0] days vs 6.0 [4.0–8.0] days; P

Objectives This study compared the condom failure rate, safety and acceptability of two new synthetic adhesive male condoms, Wondaleaf-Cap® (WLC) and Wondaleaf-On-Man® (WLM), with a marketed latex external condom Durex®-Together (DT). Study design We enrolled healthy married, monogamous, heterosexual condom users in a randomized controlled, cross-over, pilot trial in Malaysia. We randomized participants to six groups with different condom use-orders of the experimental WLC and WLM and control latex condom for four episodes for vaginal sex over 1 month for each condom type. We summarized the clinical and non-clinical failure rate, safety and acceptability of each condom type using descriptive statistics. We tested differences in condom failure and acceptability using generalized estimating equations and repeated measure ANOVA respectively. Results We screened 75 couples and randomized 50 eligible couples. Two couples withdrew before receiving any condom. The remaining used 576 condoms with 192 uses for each condom variant. Clinical failure rates of WLC, WLM and DT were 1.04%, 0% and 0.52%, respectively. Non-clinical failure rates of WLC, WLM and DT were 2.08%, 3.12% and 1.04%, respectively. Removal was found more painful with Wondaleaf products than the DT. Preferences of participants for WLC, WLM and DT were 33.3%, 29.2% and 25%, respectively. Overall, WLC and DT had greater acceptances among male participants than WLM. Conclusion Results of this pilot study support that use of synthetic adhesive male condoms is associated with failure rates similar to those seen with existing latex, and with greater acceptability. A larger study to ascertain non-inferiority is underway. Implications The availability of synthetic adhesive male condoms may increase the acceptability of condom use. However, removal pain and clinical performance requires further study.

Background and Aims: Fibroblast growth factor 21 (FGF21), an emerging metabolic hepatokine, is associated with atherosclerosis. An interaction with sex has been described in various populations. We aimed to study whether sex modulates the relationship between FGF21 and subclinical carotid atherosclerosis in a diabetes-enriched multiethnic population of Singapore. We explore differences in intermediary mechanisms, in terms of hypertension, lipids, and inflammation, between FGF21 and atherosclerosis.Methods: We recruited 425 individuals from a single diabetes center in Singapore, and demographics, anthropometry, metabolic profile, FGF21, and carotid ultrasonography were performed. Multivariable logistic regression models were used to study the association between subclinical atherosclerosis and FGF21 adjusting for age, ethnicity, body mass index (BMI), hemoglobin A1c (HbA1c), systolic and diastolic blood pressures, and low-density lipoprotein (LDL)-cholesterol separately for males and females as two groups after an interaction test.Results: An interaction test assessing interaction by sex on the relationship between subclinical atherosclerosis and FGF21 showed a significant interaction with sex (Pinteraction = 0.033). In the female subgroup, significant independent associations of standardized lnFGF21 with subclinical atherosclerosis were seen, with 1 SD increment in lnFGF21 being associated with 1.48-fold (95% CI: 1.03, 2.12; p = 0.036) increase in risk. In the male subgroup, the association of subclinical atherosclerosis with standardized lnFGF21 was not significant [odds ratio (OR) (95% CI): 0.90 (0.63, 1.28); p = 0.553]. We found sex interactions with pulse pressure being significantly associated in females only and triglycerides and C-reactive protein being associated with males only.Conclusion: FGF21 is positively associated with subclinical carotid atherosclerosis in women, but not in men. The sex–racial patterns in the mechanisms by which FGF21 causes subclinical atherosclerosis needs to be explored in larger population-based studies and mechanistically studied in greater detail.

PurposeTo study outcome of Hydrocephalus in Tuberculous Meningitis (TBMH) and factors associated with poor clinical outcome.MethodsClinical data of 143 adult patients diagnosed with TBM over a 6-year period in 2 tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data was studied. Patients with Hydrocephalus in TBM (TBMH) were further analysed based on their clinical grade and rendered treatment to identify prognostic factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment.Results The mean age of patients was 35.6P12.4 year, with a male gender predominance of 67.1%. Forty four percent had TBMH, of which 42.9% had surgical intervention. In the good Modified Vellore Grade, 76.5% was managed medically with concurrent ATT, steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subsequently. Poor outcome (65.2%) was seen in the poor Modified Vellore Grade despite medical and surgical intervention. Multivariate model Multiple Cox Regression showed significant results for seizure (adjusted HR: 15.05, 95%CI: 3.73, 60.78), GCS (adjusted HR: 0.79, 95%CI: 0.70, 0.89) and CSF cell count (adjusted HR: 1.11, 95%CI: 1.05, 1.17).Conclusion Hydrocephalus was seen in 44% of patients in this study. GCS score, seizure and high CSF cell count were factors associated with a poor prognosis in TBM. Patients with TBMHM had better survival function compared to those with TBMHS (p value

IntroductionThis study examined the effectiveness of a structured group-based intervention “MEDIHEALTH” in improving medication adherence and the glycated haemoglobin (HbA1c) level. MethodsStudy design: Two groups, parallel randomized controlled trial with 1:1 allocation.Total respondents: 142 (68 in intervention group; 63 in control group).Study sites: Petra Jaya and Kota Samarahan health clinics of Sarawak.Instrument and validity:Medication Adherence of 0.932. Results [Refer to Poster]. Discussion / ConclusionThe MEDIHEALTH group had a significantly greater increase in the SEAMS score compared to the control group (p < 0.001) at one, three, six and twelve months post-intervention. There was also a significantly greater reduction in HbA1c in the MEDIHEALTH compared to the control group at three, six and twelve months postintervention (p < 0.001). The MEDIHEALTH may improve medication adherence and glycaemic control among Malay T2DM patients

IntroductionThis study investigated the level of and the influence of socio-demographic characteristics, knowledge, attitude, subjective norm and self-efficacy on the intention to donate hematopoietic stem cells (HSC) among blood donors. Methods[Refer to Poster]. Results[Refer to Poster]. Discussion / ConclusionOverall, 87.1% reported a positive intention to donate HSC. Concerns about the regulations of HSC donation, potential side effects of HSC donation must be addressed while promoting HSC donation. Improving subjective norms and self-efficacy about HSC donate may enhance their intention to donate. The findings are useful for the development of strategies for donor recruitment in the region.

Impairments in walking speed, capacity, and endurance are commonly seen after stroke. Treadmill training improves endurance and gait speed. However, the lack of variable training speed and automated speed progression increases the risk of backward displacement and falling. An automated, speed-sensing treadmill prototype with partial body weight support, the Variable Automated Speed and Sensing Treadmill II (VASST II), was tested in an outpatient rehabilitation setting. Eleven subacute or chronic hemiplegics who could ambulate at > 0.2 m/s for >50 m participated in the study. All subjects underwent physiotherapist-supervised training on VASST II for 60 min daily, 3 times per week, for 5 weeks (total 15 h). Outcome measures at Week 3 (mid-VASST II training), Week 6 (post-VASST II training), Week 12 (first follow-up), and Week 24 (second follow-up) included the 6 minute walk test (6 MWT), 10 meter walk test (10 MWT), Berg Balance Scale (BBS) score, and Functional Ambulation category (FAC) score. User acceptability of VASST II for both study subjects and physiotherapists were also assessed. All subjects [median (IQR) age: 53.0 (22) years; median (IQR) duration post-stroke: 524 (811) days] completed VASST II training. At baseline, mean ± SD 6 MWT was 114 ± 50.9 m; mean ± SD 10 MWT was 0.37 ± 0.18 m/s; mean ± SD BBS score was 40 ± 10; and, mean ± SD FAC score was 4 ± 1. At Week 6, there were significant improvements in the 6 MWT [158.91 ± 88.69 m; P = 0.003], 10 MWT [0.49 ± 0.30 m/s; P = 0.016], and BBS score [42 ± 10; P = 0.003]. Improvements in 6 MWT and BBS scores were sustained at Week 24, but not in the 10 MWT. No VASST II-training related falls were reported. All subjects rated their VASST II training positively and indicated that it improved their current walking ability. VASST II training was effective, feasible, and safe in patients with subacute or chronic post-stroke hemiparetic gait, with sustained gains in distance walked (6 MWT) and functional balance (BBS score) up to 19 weeks post-intervention.

BACKGROUND: Chest radiography (CXR) is performed more widely and readily than CT for the management of coronavirus disease (COVID-19), but there remains little data on its clinical utility. This study aims to assess the diagnostic performance of CXR, with emphasis on its predictive value, for severe COVID-19 disease. METHODS: A retrospective cohort study was conducted, 358 chest radiographs were performed on 109 COVID-19 patients (median age 44.4 years, 58 males and 30 with comorbidities) admitted between 22 January 2020 and 15 March 2020. Each CXR was reviewed and scored by three radiologists in consensus using a 72-point COVID-19 Radiographic Score (CRS). Disease severity was determined by the need for supplemental oxygen and mechanical ventilation. RESULTS: Patients who needed supplemental oxygen (n=19, 17.4%) were significantly older (P

Background To determine the utility of chest radiography (CXR) for assessing and prognosticating COVID-19 disease with an objective radiographic scoring system.Methods A multicenter, prospective study was conducted, forty patients were included. Seventy-eight CXR’s were performed on the first derivation cohort of twenty patients with COVID-19 (median age 47.5 years, 10 females and four with comorbidities) admitted between 22 January 2020 and 1 February 2020. Each CXR was scored by three radiologists in consensus and graded on a 72-point COVID-19 Radiographic Score (CRS). This was correlated with supplemental oxygen requirement, C-reactive protein (CRP), lactate dehydrogenase (LDH) and lymphocyte count. To validate our findings, the parameters of another validation cohort of twenty patients with 65 CXRs were analysed.Results In the derivation cohort, seven patients needed supplemental oxygen and one was intubated for mechanical ventilation with no death. The maximum CRS was significantly different between patients on and not on supplemental oxygen (p=Conclusion Using an objective scoring system (CRS), the degree of abnormalities on CXR correlates closely with known markers of disease severity. CRS may further be applied to predict patients who require oxygen supplementation during the course of their disease.

Amidst the high disease burden, non-adherence to medications among patients with type 2 diabetes mellitus (T2DM) has been reported to be common and devastating. Sarawak Pharmaceutical Services Division has formulated a pharmacist-led, multiple-theoretical-grounding, culturally sensitive and structured group-based program, namely “Know Your Medicine – Take if for Health” (MEDIHEALTH), to improve medication adherence among Malay patients with T2DM. However, to date, little is known about the effectiveness and sustainability of the Program. This is a prospective, parallel-design, two-treatment-group randomized controlled trial to evaluate the effectiveness and sustainability of MEDIHEALTH in improving medication adherence. Malay patients who have underlying T2DM, who obtain medication therapy at Petra Jaya Health Clinic and Kota Samarahan Health Clinic, and who have a moderate to low adherence level (8-item Morisky Medication Adherence Scale, Malaysian specific, score

Objectives 3D-printed (3DP) customized temporary cranial protection solutions following decompressive craniectomy (DC) are currently not widely practiced. A pilot trial of a 3DP customized head protection prototype device (HPPD) on 10 subjects was conducted during the subacute rehabilitation phase. Materials and methods Subjects > 30 days post-DC with stable cranial flaps and healed wounds were enrolled. HPPD were uniquely designed based on individuals’ CT scan, where the base conformed to the surface of the individual’s skin covering the cranial defect, and the lateral surface three-dimensionally mirrored, the contralateral healthy head. Each HPPD was fabricated using the fused deposition modeling method. These HPPD were then fitted on subjects using a progressive wearing schedule and monitored over 1, 2, 4, 6 and 8 follow-up (FU) weeks. Outcomes during FU included; reported wearing time/day (hours), subjective pain, discomfort, pruritus, dislodgment, cosmesis ratings; and observed wound changes. The primary outcome was safety and tolerability without pain or wound changes within 30 minutes of HPPD fitting. Results In all, 10 enrolled subjects received 12 HPPDs [5/10 male, mean (SD) age 46 (14) years, mean (SD) duration post-DC 110 days (76)] and all subjects tolerated 30 minutes of initial HPPD fitting without wound changes. The mean (SD) HPPD mass was 61.2 g (SD 19.88). During 8 weeks of FU, no HPPD-related skin dehiscence was observed, while 20% (2/10) had transient skin imprints, and 80% (8/10) reported self-limiting pressure and pruritis. Discussion Findings from this exploratory study demonstrated preliminary feasibility and safety for a customized 3DP HPPD for temporary post-DC head protection over 8 weeks of follow-up. Monitoring and regular rest breaks during HPPD wear were important to prevent skin complications. Conclusion This study suggests the potential for wider 3DP technology applications to provide cranial protection for this vulnerable population.

Background Metabolic syndrome (MS), the concurrence of hypertension, abdominal obesity, dyslipidemia and glucose intolerance, is an important risk factor for type II diabetes mellitus (T2DM) and cardiovascular disease (CVD). CVD is a leading cause of morbidity and mortality in patients with rheumatoid arthritis (RA). Studies in RA suggest that inflammation and glucocorticoid use predispose to MS, and that MS is associated with active disease. Objectives To investigate the prevalence and characteristics of MS in our cohort of RA patients. Methods A total of 409 patients who fulfilled the 1987 ACR criteria for RA and with complete data for classification of MS were included. MS was defined according to the Adult Treatment Panel III report of the National Cholesterol Education Programme (NCEP/ATP III). Information related to demographics, disease onset, serologies, disease activity and treatment was collected. Independent t-test or Mann-Whitney U test was used to compare continuous quantitative data, while Pearson Chi-square or Fisher Exact test for categorical data. Logistic regression was used to identify factors associated with of MS. All the statistical tests were two sided, and p value Results Fifty-two patients (12.7%) fulfilled the criteria for MS. Most of the patients in the cohort were female (85.3%) and non-smokers (84.6%). The mean age was 60.5±11.09 years and mean BMI 23.67±5.06. The patients with MS were significantly older (age 64.21+8.63 vs 59.96±11.32, p=0.010). The mean disease duration was 14.09±9.74 years. Rheumatoid factor and anti-cyclic citrullinated peptide antibody were present in 80.0% and 95.1% respectively. 4.4% of them had a history of CVD or stroke/transient ischaemic attack but the prevalence was the same in patients with and without MS. Comparing the two groups, there was no significant difference in the history of ever-smoking (15.4% vs 15.4%, p=0.699), disease duration (16.44±10.11 vs 13.72±9.66 years, p=0.060), cumulative glucocorticoid use (p=0.649), DAS28 score (2.12±1.09 vs 2.11±1.24, p=0.458) and HAQ score (0.13 vs 0.13, p=0.767). There was also no significant difference in the use of methotrexate, leflunomide or biologics. The commonest MS criteria fulfilled were hypertension (88.5%) and dyslipidaemia (84.6%). 46.2% of the patients with MS had T2DM. Males were less likely to have MS than females [adj. OR (95%CI): 0.039 (0.005, 0.292), p=0.002]. Conclusion MS is found in 12.7% of our RA patients and they were significantly older than those without MS. In our study, MS does not have a significant association with RA disease activity, disease duration, glucocorticoid usage or disease modifying anti-rheumatic treatment. References [1] Rostom S, et al. Metabolic syndrome in rheumatoid arthritis: case control study. BMC Musculoskeletal Disorders. 2013 Apr 26;14:147. [2] Tantayakom P, et al. Metabolic syndrome is associated with disease activity in patients with rheumatoid arthritis. Joint Bone Spine. 2016 Oct;83(5):563 Disclosure of Interests None declared

Background The Rheumatology Attitudes Index (RAI) is a questionnaire comprising of fifteen questions that assesses a patient’s beliefs and perception of helplessness and the ability to control rheumatoid arthritis (RA). However, the relationship between RAI and patient demographics, disease activity and functional status is inadequately explored. Objectives We analysed the association of RAI with educational level, Physician’s Global Assessment of Activity (DGA), Patient’s Global Assessment of Activity (PGA), Disease Activity Score (DAS 28), and Health Assessment Questionnaire (HAQ). We also investigated if RAI is sensitive to change over a six-month period in comparison with DGA, PGA, DAS28 and HAQ. Methods All patients from Tan Tock Seng Hospital, a tertiary hospital in Singapore, who fulfilled the 1987 ACR criteria for RA, and completed the self-administered RAI questionnaire twice over six months were included. We analysed the DAS28, DGA, PGA and HAQ. Repeated measure ANOVA was used to analyse the association between RAI and educational level. Spearman correlation was used to study the association between RAI and the parameters DAS 28, HAQ, DGA and PGA, both cross-sectionally and longitudinally. We used SPSS version 19.0 (IBM Corp, Armonk, NY). P-value Results There were 501 patients suitable for study. The mean age of disease onset was 43 years and mean disease duration was 15 years. The majority were Chinese (83.4%), married (68.5%) and most (79.4%) received fewer than 10 years of education. About half (50.7%) of the participants suffered from hypertension, 13.6% diabetes mellitus, 61.5% hyperlipidaemia, 20.8% renal disease, 21.6% liver disease and 16.6% thyroid disorder. Patients with 10 years of education. Cross-sectionally, weak positive correlation was found between RAI and DAS 28 (r = 0.225, p Conclusion Higher RAI scores denoting greater perceived helplessness were associated with higher RA activity, HAQ, PGA and DGA. RAI was responsive to change over a six-month period compared with these four parameters. High RAI score was also associated with lower educational level. Higher RAI scores reflects higher disease activity and worse functional status in a cross-sectional cohort and for the same patient longitudinally. Reference [1] Stein MJ, et al. Factor structure of the Arthritis Helplessness Index. J Rheumatol198815(3): 427-32 Disclosure of Interests None declared

Amidst the high disease burden, non-adherence to medications among patients with type 2 diabetes mellitus (T2DM) has been reported to be common and devastating. Sarawak Pharmaceutical Services Division has formulated a pharmacist-led, multiple-theoretical-grounding, culturally sensitive and structured group-based program, namely "Know Your Medicine - Take if for Health" (MEDIHEALTH), to improve medication adherence among Malay patients with T2DM. However, to date, little is known about the effectiveness and sustainability of the Program.This is a prospective, parallel-design, two-treatment-group randomized controlled trial to evaluate the effectiveness and sustainability of MEDIHEALTH in improving medication adherence. Malay patients who have underlying T2DM, who obtain medication therapy at Petra Jaya Health Clinic and Kota Samarahan Health Clinic, and who have a moderate to low adherence level (8-item Morisky Medication Adherence Scale, Malaysian specific, score6) were randomly assigned to the treatment group (MEDIHEALTH) or the control group. The primary outcome of this study is medication adherence level at baseline and 1, 3, 6 and 12 months post-intervention. The secondary outcomes are attitude, subjective norms, perceived behavioural control, intention and knowledge related to medication adherence measured at baseline and 1, 6 and 12 months post-intervention. The effectiveness and sustainability of the Program will be triangulated by findings from semi-structured interviews with five selected participants conducted 1 month after the intervention and in-depth interviews with two main facilitators and two managerial officers in charge of the Program 12 months after the intervention. Statistical analyses of quantitative data were conducted using SPSS version 22 and Stata version 14. Thematic analysis for qualitative data were conducted with the assistance of ATLAS.ti 8.This study provides evidence on the effectiveness and sustainability of a structured group-based educational program that employs multiple theoretical grounding and a culturally sensitive approach in promoting medication adherence among Malays with underlying T2DM. Both the quantitative and qualitative findings of this study could assist in the future development of the Program.National Medical Research Register, NMRR-17-925-35875 (IIR). Registered on 19 May 2017. ClinicalTrials.gov, NCT03228706 . Registered on 25 July 2017.

Background. Diabetes quality of life (DQoL) instrument has been widely used to measure quality of life among diabetes patients. This study aimed to develop a revised version of DQoL instrument that incorporated issues of redundancies in the items and strengthen the basis of validity of the instrument. Methods. This was a cross-sectional study where diabetes patients were recruited from December 1, 2014, until end of March 2015 at a public health clinic in Peninsular Malaysia. A questionnaire that included patients’ information and DQoL instrument was distributed to patients. Item selection of DQoL instrument was conducted to screen and finalize the items based on issues of missing values and redundancy. Validity testing was conducted for the revised DQoL instrument based on exploratory factor analysis, confirmatory factor analysis, and Rasch analysis. Results. The pattern structure matrix yielded three domains similar to the original version with 18 items. The minimum factor loading from the structure matrix was 0.358. The item’s and person’s reliability was excellent with 0.92 and 0.84 for “satisfaction” domain, 0.98 and 0.60 for “impact” domain, and 0.99 and 0.57 for “worry” domain, respectively. Confirmatory factor analysis has dropped 5 items and the revised version of DQoL contained 13 items. Composite reliability of the revised version was computed for “satisfaction” domain (0.922; 95% CI: 0.909–0.936), “impact” domain (0.781; 95% CI: 0.745–0.818), and “worry” domain (0.794; 95% CI: 0.755–0.832). Conclusion. A revised version of DQoL that maintains the conceptualization of “satisfaction,” “impact,” and “worry” with 13 items was successfully developed.